Provider Demographics
NPI:1629372420
Name:CROME, GINA M (RD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:CROME
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W FOOTHILL BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3386
Mailing Address - Country:US
Mailing Address - Phone:626-963-5350
Mailing Address - Fax:
Practice Address - Street 1:303 W FOOTHILL BLVD STE 11
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3386
Practice Address - Country:US
Practice Address - Phone:626-963-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055366133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered